SubmissionId 60532

Accepted Type
Oral

Code
OA3-2-3

Acceptance Declaration
Accept

Additional Information
I declare I have no actual or potential conflict of interest in relation to this program.

Was this work accepted for CCME 2020?
yes

Category
General Call (Workshop, Oral Presentation, Poster Presentation)

Type
Oral

Sub Type
Education Research

Will the presenter be a:
Student

Affiliation

Considered for Poster
yes

Title
Rethinking "The [Past] Medical History": An Exploration of Patient Networks of Care Providers

Length of Presentation

Background/Purpose
Patients' networks of care providers have largely been ignored in current models of history taking. That each patient relies on a family physician who helps them navigate the healthcare system is largely assumed. For many hospitalized patients -especially those with multi-morbidity -this may not accurately reflect their reality. Moreover, failing to consider alternative care networks could lead to inadequate care planning.

Methods
Prospective cohort study with data collection and analysis informed by constructivist grounded theory methodology. Data included interview transcripts from 30 patients admitted to an inpatient internal medicine service of an urban academic health centre. Analysis and data collection proceeded in an iterative fashion with sampling progressing from purposive to theoretical.

Results
We found a complex interplay among the types of family physician relationship (highly involved, less involved, non-existent), specialist relationship(s) (highly involved, consultative, fragmented), and patients' personal abilities/social supports. These configurations appeared to impact how each cared for self and navigated the healthcare system. Those with less optimal combinations described many challenges during transitions in medical care arising from hospital admission, new diagnoses, increasing medical complexity, and changes in functional ability.

Conclusion
Our elaboration of the multiple configurations of care networks has implications for teaching history taking. Adapting history taking to more effectively identify care networks can help guide discharge and ongoing care planning for high risk patients. Doing so requires moving from "past medical history" to "chronic active issues," and exploring the associated network of care providers and social context.

Keyword 1
network of care

Keyword 2
medical history

Keyword 3
multi-morbidity

Level of Training
Undergraduate

Abstract Themes
Teaching and learning

Teaching and Learning
  • Clinical Context
  • Clinical Skills
  • Patient Safety

Additional Theme (First choice)
Patient Safety

Additional Theme (Second Choice)
Leadership

Additional Theme (Third Choice)

Authors
Presenter
    Laurent Perrault-Sequeira

Term 1
Yes

Term 2
Yes

Term 3
Yes

Term 4
Yes

Term 5
Yes
x

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